Mix Flashcards
Mitral Stenosis
Diastolic - S1 Murmur
Low-pitched - THRILL on palpitation
LEFT 5th ICS; apex
Aortic Regurgitation
Diastolic- Hight-pitched blowing sound
LEFT 2nd ICS
Mitral Regurgitation
Systolic - Musical blowing, high pitched
Follows S3 and radiates to base or axilla
LEFT 5th ICS; apex
Aortic Stenosis
Systolic - Rough, harsh blowing
Radiates to neck
RIGHT 2nd ICS
S1
Mitral/Tricuspid (atrial ventricular) valves close
S2
Aortic/Pulmonic (semilunar valves) close SOUND IS HEARD
Split S2 is best heard at pulmonic
S3
“Ken-tuck-y”
Diastole
LEFT 5th ICS; mid-clavicular space at apex
Ex: Left side heart failure ,CHF
Normal: Pregnancy, athletes, children, >40yo
S4
“Ten-ne-ssee”
Diastole
Atrial gallop or kick, Absent in Afib
LEFT 5th ICS mid-clavicular
Ex: MI, Left ventricular hypertrophy, Chronic HTN
Normal in elderly
Lipid Panel
Cholesterol <200
Triglycerides <150
LDL <100
HDL >40
Platelets
150,000 - 450,000
HGB/HCT
HGB. 14 - 18 (M)
12 - 16 (F)
HCT 40 -54% (M)
37 - 47% (F)
Calcium
8.5 - 10
Iron
50 -150
ALT/AST
ALT 0-40
AST 0-45
BUN
10- 20
Creatinine
0.5 - 1.5
TSH
0.5 - 5
T4
5 - 13
Aldosterone
0.8 - 1.4
Diagnostics for DM2
Serum FBG >126
Random BG >200 w. hyperglycemia
Plasma BG >200 after preload
A1C > 6.5% (Normal <5.7)
Criteria for Metabolic Syndrome
FBG >100
BP > 130/85
Triglycerides > 150
HDL <40 (M) <50 (F)
Waist circumference >40 (M) 101.6
>35 (F) 88.9
Mini Mental Status Exam
Appearance
Behavior
Cognition
Thought Process
30-24 None
23-18 (Mild)
17- 0 (Severe)
TIBC
Total Iron Binding Capacity
250 - 450
MCV
Mean Corpuscular Volume
80 - 100
Microcytic <80
Normal 80 - 100
Macrocytic >100
MCHC
Mean Corpuscular Hemoglobin Concentration
32 - 36
HYPOchromic <32
Normal 32 - 36
HYPERchromic >36
Microcytic - Hypochromic
Conditions?
Iron deficiency anemia
Thalassemia
Macrocytic - Normochromic
Conditions?
Folic acid deficiency
Pernicious anemia (B12)
Normocytic - Normochromic
Conditions?
Anemia of chronic disease
Otitis Media (bacterial)
Amoxicillin - clavulante (if no prior abx)
Cephalosporin
Acute bacterial rhinosinusitis
Amoxicillin - clavulanate (Augmentin)
Levofloxacin or Doxycycline
Cefdinir
Allergic Rhinitis
Fluticasone (Flonase)
Cetirizine (Zytrec)
Loratadine (Claritin)
Pharyngitis (Strep)
Penicillin V 500 mg BID x 10 days
Amoxicillin 500 mg BID x 10 days
Azithromycin x 5 days
Acute bronchitis (bacterial)
Macrolides
Doxycycline
TMP-SMN (Bactrim)
SABA
Albuterol
Levalbuterol
ICS
Budesonide
Fluticasone
SAMA
Ipratropium
(short acting anticholinergics)
LABA
Formoterol
Salmeterol
LAMA
Tiotropium
Pertussis (Whooping cough)
Macrolids (-mycins)
Pneumonia CAP (no comorbidities or abx x3 months)
Amoxicillin 1g TID
Doxycycline 100 mg BID
Azithromycin
Pneumonia CAP ( w. comorbidities & risk factors for resistance)
Amoxicillin - clavulanate
Cephalosporin PLUS Macrolide
Doxycycline
Mono therapy - Fluquinolones
Tuberculosis
R.I.P.E
Rifampin, Isonizid (INH), Pyrazinamide, Ethambutol
6 month tx
9 month tx w HIV
Peptic ulcer disease + H.pylori
Clarithromycin
Amoxicillin
Omeprazole
Bismuth
14 day tx
Neonates, children, and adolescents
w. bacterial infections, meningitis, otis media, and gonnorhea
Ceftriaxone (Rocephin)
Acute prostatitis
Ceftriaxone 250 mg IM once
Chylamydia (complicated)
Doxycycline 100 mg BID x 14 days
Chylamydia (uncomplicated)
Azithromycin 1g
Doxycycline 100 mg BID x 7 days
Gonnorhea (complicated)
Ceftriaxone 250 mg IM PLUS Doxycycline 100 mg BID x 14 days
Gonnorhea (uncomplicated)
Ceftriaxone 250 mg IM PLUS Azithromycin 1 g
Epididymitis
STD related and <35yo: Ceftiraxone 500 mg IM PLUS Doxycycline for 10 days
Enteric organism and >35yo: Levofloxacin 500 mg x days
BPH
Tamsulosin (Flomax)
Finesteride
Bacterial vaginosis
Metronidazole (oral or vaginal)
Clindamycin cream
Trichomoniasis
Metronidazole 500 mg BID x 7 days
Vaginal candidiasis
-dazoles
Not metronidazole
Pelvic Inflammatory Disease
Ceftriaxone 500 mg IM once PLUS Doxy PLUS
Metronidazole all for 14 days
Associated conditions with Polycystic Ovary Syndrome (PCOS)
Diabetes,
Metabolic syndrome,
Infertility,
Heart and blood vessel complications,
uterine cancer,
sleep apnea
Syphilis
Primary: Benzathine penicillin B
Secondary: Doxycycline
UTI - uncomplicated
Nitrofurontoin (Macobid for preg)
TMP-SMX
Cephalexin
Pyelonephritis
Ciprofloxacin BID x 7- 14 days OR
Levofloaxcin
Ceftriaxone 1g IM IV Q24h x 14 days
Cellulitis w/o MRSA
Dicloxacillin
Amoxicillin
Cephalexin (Keflex)
Cellulitis w. MRSA
TMP - SMX (Bactrim)
Doxycycline 10 days
Clindamycin x 10 days
Lyme Disease
Doxycycline 100 BID x 21 days
Rocky Mountain Spotted Fever
Doxycycline
Anthrax (Skin)
Ciprofloxacin x 60 days
Doxycyline
Bullous myringitis
Amoxicillin 500 mg Q8h x 10 days
Urate lowering drugs (Gout)
Allopurinol
Febuxostat
Condyloma acuminata & actinic keratosis
Imiquimod (Aldara)
Acceptable drugs s/p MI in elderly
Diuretics
ACE
Beta blockers
Hepatitis A
Active: Anti-HAV & IgM
Recovered: Anti-HAV & IgG
Hepatitis B
Active: HBsAg, HBeAG, Anti-HBc, IgM
Chronic: HBsAg, Anti-HBc, Anti-HBe, IgM, IgG
Recovered: Anti-HBc, Anti-HBs
Hepatits C
Active: Anti-HCV, HCV RNA *Order a PCR to differentiate between both
Deep pain on inspiration with fingers placed under RIGHT SIDE of rib cage
Murphy’s sign - Cholecystitis
Point tenderness between anterior iliac spine and umbilicus
McBurney’s sign - Appendicitis
Pain with RIGHT thigh extension after bending
Psoas sign - Appendicitis
Pain with internal rotation of flexed RIGHT thigh
Obturator - Appendicitis
RIGHT lower quadrant pain when pressure applied to LEFT lower quadrant
Rovings sign - Appendicitis
Bluish discoloration around umbilicus
or the flank - pain radiates from abdomen to flank
Cullens (umbilicus)
Turner (flank)
Pancreatitis
Knee is raised with foot externally rotated and flexed and straightened; results in audible/palpable click
McMurray’s sign - Meniscus
Assesses anterior cruciate ligament tears (ACL)
Lachman drawer test - ACL
Performed by having the patient lie supine and raising the patient’s affected leg to the point of pain or 90 degrees with the knee extended. This is indicative of a herniated disc.
Straight leg test
Positive when tapping over the median nerve on the flexor surface of the wrist causes tingling.
Tinell test - Carpal tunnel
Having a patient bring both wrists into flexion and then bringing the dorsums of the hands together
Phalen sign - Carpal tunnel
Two tests for meningitis
Brudzinski: Neck stiffness
Kernig: Knee hip stiffness
Occurs when scrotal pain is alleviated with the physical lifting of the testicles
Prehn sign (+) - epididymitis
A reflex that is elicited by stroking the inner thigh, which causes the cremaster muscle to contract and pull up the ipsilateral testicle toward the inguinal canal.
Cremasteric reflex - testicular torsion
Scaphoid injury
Watson Stress Test
CURB-65
> 65
AMS
BUN >19
RR > 30
BP <90/60
Obstructive lung disease
Asthma
Chronic bronchitis
Emphesema
COPD
Restrictive lung disease
Morbid obesity
Pulmonary fibrosis
Sarcoidosis